Management and Healthcare Laboratory, Institute of Management and Department EMbeDS, Scuola Superiore Sant'Anna, Scuola Superiore Sant'Anna, 56127, Pisa, Italy.
UOC Cardiologia e Medicina Cardiovascolare, Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica, Pisa, Italy.
BMC Health Serv Res. 2022 Sep 10;22(1):1146. doi: 10.1186/s12913-022-08522-0.
Worldwide healthcare systems face challenges in assessing and monitoring chronic care pathways and, even more, the value generated for patients. Patient-reported outcomes measures (PROMs) represent a valid Real-World Evidence (RWE) source to fully assess health systems' performance in managing chronic care pathways.
The originality of the study consists in the chance of adopting PROMs, as a longitudinal assessment tool for continuous monitoring of patients' adherence to therapies and self-care behavior recommendations in clinical practice and as a chance to provide policy makers insights to improve chronic pathways adopting a patient perspective. The focus was on PROMs of patients with chronic heart failure (CHF) collected in the Gabriele Monasterio Tuscan Foundation (FTGM), a tertiary referral CHF centre in Pisa, Italy. During the hospital stay, CHF patients were enrolled and received a link (via SMS or email) to access to the first questionnaire. Follow-up questionnaires were sent 1, 7 and 12 months after the index hospitalisation. Professionals invited 200 patients to participate to PROMs surveys. 174 answers were digitally collected at baseline from 2018 to 2020 and analysed. Quantitative and qualitative analyses were conducted, using Chi2, t-tests and regression models together with narrative evidence from free text responses.
Both quantitative and qualitative results showed FTGM patients declared to strongly adhere to the pharmacological therapy across the entire pathway, while seemed less careful to adhere to self-care behavior recommendations (e.g., physical activity). CHF patients that performed adequate Self-Care Maintenance registered outcome improvements. Respondents declared to be supported by family members in managing their adherence.
The features of such PROMs collection model are relevant for researchers, policymakers and for managers to implement interventions aimed at improving pathway adherence dimensions. Among those, behavioral economics interventions could be implemented to increase physical activity among CHF patients since proven successful in Tuscany. Strategies to increase territorial care and support patients' caregivers in their daily support to patients' adherence should be further explored. Systematic PROMs collection would allow to monitor changes in the whole pathway organization. This study brings opportunities for extending such monitoring systems to other organizations to allow for reliable benchmarking opportunities.
全球医疗保健系统在评估和监测慢性病管理路径方面面临挑战，更不用说为患者创造的价值了。患者报告的结果测量（PROMs）是一种有效的真实世界证据（RWE）来源，可以全面评估医疗系统在管理慢性病管理路径方面的表现。
该研究的新颖之处在于采用 PROMs 作为一种纵向评估工具，用于连续监测患者在临床实践中对治疗的依从性和自我护理行为建议，并为决策者提供改善慢性病路径的见解，采用患者视角。重点是意大利比萨加布里埃莱·蒙泰罗蒂西基金会（FTGM）收集的慢性心力衰竭（CHF）患者的 PROMs，FTGM 是一家三级转诊 CHF 中心。在住院期间，招募 CHF 患者并向他们发送链接（通过短信或电子邮件）以访问第一个问卷。在索引住院后 1、7 和 12 个月发送随访问卷。专业人员邀请了 200 名患者参与 PROMs 调查。2018 年至 2020 年期间，从基线收集了 174 份数字回答并进行了分析。使用 Chi2、t 检验和回归模型进行定量和定性分析，同时结合自由文本回复中的叙述证据。
定量和定性结果均表明，FTGM 患者在整个路径中都强烈遵守药物治疗，但似乎对遵守自我护理行为建议（例如体育活动）不太注意。进行适当自我护理维持的 CHF 患者报告了结果的改善。受访者表示在管理自己的依从性方面得到了家庭成员的支持。
这种 PROMs 收集模型的特点对于研究人员、政策制定者和管理者实施旨在改善路径依从性的干预措施具有重要意义。其中，行为经济学干预措施可以在 Tuscany 被证明成功的情况下，增加 CHF 患者的体育活动。应该进一步探索增加地区护理和支持患者护理人员在日常支持患者依从性方面的策略。系统地收集 PROMs 将允许监测整个路径组织的变化。这项研究为将这种监测系统扩展到其他组织以实现可靠的基准机会提供了机会。
